Rural areas exposed by lack of cholera knowledge

BINDURA, (IRIN) – A lack of understanding about cholera and a failure to adapt social customs in rural Zimbabwe to curb the waterborne disease is ensuring that the death toll will keep rising.

Cholera has rampaged through Zimbabwe since August 2008, killing more than 4,000 people and infecting over 91,000, and although the World Health Organization (WHO) recently said reports of new cases were slowing, it warned that the "the risk of the outbreak restarting" was "real".

Early in March, Simplicius Mushayakarara, 49, returned to his rural home in Musana, about 85km northeast of the capital, Harare, after attending a funeral. His stepdaughter died from cholera but he and his wife were saved by the intervention of their son, who works in the nearby town of Bindura, in Mashonaland Central Province.

"We had just returned from the funeral of a relative who died in Harare when the three of us fell ill, suffering from diarrhoea. We had no reason to suspect it was cholera because we were not told the cause of the death of my relative," Mushayakarara told IRIN.

Funeral customs

"At the funeral we freely shook hands, as our custom requires, ate food without properly washing our hands, and some of us even touched the body of the deceased person as a way of bidding him farewell. To us, cholera was a disease that only occurred in towns and cities," he said.

Mushayakarara’s son, Tatenda, arrived at their home by chance, after coming to the district to pay his respect to the family of a recently deceased relative, and immediately recognized the symptoms. He was too late to prevent his sister’s death, but his quick thinking saved his parents.

"Tatenda gave us a salt and sugar solution and organized transport that ferried us to Bindura, where we were hospitalised and treated,” Mushayakarara said. "We came back to bury our daughter, and I will always be grateful to my son because, were it not because of him, we would all have perished without knowing what disease had hit us."

That week in Musana, six people from four different families also died, "and that is when we became aware that cholera was not only confined to urban areas but could easily spread in villages as well," Mushayakarara said.

''That is when we became aware that cholera was not only confined to urban areas but could easily spread in villages as well''

Before the outbreak, villagers had only received scant details of a disease killing people in urban areas and were unaware of the symptoms of the disease or how it spread.

Sekai Chapwanya, 38, a community-based HIV/AIDS caregiver in a neighbouring village, has urged health officials to ramp up cholera education campaigns. "The majority of the people living in rural communities lack knowledge on how best to prevent cholera," she told IRIN.

"Health officials seem to have been concentrating on urban areas, maybe because that is where most of the deaths have occurred. The cholera outbreak might have started in cities but it has found its way here as well."

Since cholera gained a foothold in rural areas Chapwanya has concentrated on teaching communities about preventing and curing the disease, with some tacit support from NGOs but none from government.

Cholera education

"I do my visits only when I am not tending my own crops, a situation that makes the anti-cholera fight difficult," she said.

The incidence of cholera in Musana is relatively low compared to other parts of the province, as Chapwanya recently discovered when she embarked on a 50km journey on foot to bury a friend who had died from the disease.

The spread of cholera was worsened by the rainy season she said, and rural communities depended on water from the rivers for drinking and cooking.

"Villagers also wash in the same rivers, and sometimes relieve themselves in places close to water sources used by the people. There are hardly any boreholes, as those that were sunk long back have broken down and no-one is coming to repair them," Chapwanya said.

Rural clinics hardly functioned, so the sick had to travel long distances for medical care. "That means a lot of deaths are occurring at home and on the way to the hospitals," Chapwanya said.

Innocent Makwiramiti, a Harare-based economist, told IRIN that rural populations were vulnerable to disease outbreaks because of poverty and lack of access to resources.

"Rural areas have not been spared by the economic meltdown, and that makes them particularly susceptible, because health centres are not functioning, roads are in a poor state and people in those areas suffer low literacy rates," he said.

Sinking boreholes

Tsitsi Singizi, the UN Children’s Fund (UNICEF) Zimbabwe spokesperson, told IRIN the organization had embarked on cholera education in the rural areas.

"We are also providing non-food items to promote standard hygiene in cholera-affected areas, and these include the soaps and buckets used in chlorination, while at the same time providing oral and intravenous rehydration," she said.

"As UNICEF, we are involved in response management and prevention in rural areas, in the wake of the cholera outbreak. We have been drilling boreholes in rural communities nationwide to ensure safe water for consumption, and we started this programme well before the cholera outbreak."